اخبار
  • ایجاد شبکه دانشگاههای پزشکی کشورهای اسلامی
    مدیر روابط بین الملل دانشگاه علوم پزشکی تهران از تایید پیش نویس طرح ایجاد شبکه دانشگاههای پزشکی کشورهای اسلامی خبر داد و گفت: دانشگاه علوم پزشکی تهران به عنوان دبیرخانه این شبکه تعیین شد.
  • آغاز ثبت نام و ارسال مدارک کنکور ارشد پزشکي
    ثبت نام و ارسال مدارک در آزمون کارشناسي ارشد رشته هاي گروه پزشکي سال تحصيلي 91 - 90 از 4 اسفند آغاز شده و تا 24 اسفند ادامه دارد.
  • رشد 55 درصدي بودجه آموزش پزشكي در سال آينده
    به گفته عضو هيات رييسه كميسيون آموزش و تحقيقات مجلس شوراي اسلامي، اگرچه اعتبارات خوبي براي حوزه پژوهش وزارت علوم در نظر گرفته شده است، اما بايد مشخص شود كه بودجه پژوهشي قابل توجهي كه براي معاونت علمي و فناوري رياست جمهوري براي اختصاص به دانشگاه‌ها و پژوهشگاه‌هاي كل كشور در نظر گرفته شده به تمام استان‌ها و نقاط مختلف كشور تزريق مي‌شود يا خير؟
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  • خلاصه مقاله:

    Pyocolpos is a rare clinical finding in vaginal atresia, especially in
    childhood. We present a child with pyocolpos and a long history
    of severe sterile dysuria before she was admitted to hospital with
    fever, urinary tract infection, and abdominal mass.

    نویسندگان: Hamidreza Badeli, Mirnezam Mircharkhchian, Amir Pirooz
    کلید واژه ها: infant, hymen abnormalities, vaginal disease, dysuria
  • خلاصه مقاله:

    Childhood hypertension has been extensively focused on in the
    past decades because of its increasing incidence, which is related
    to physicians’ awareness and the increasing number of obese
    children. Age, gender, and body size are the main determinants of
    blood pressure in children. The revised childhood blood pressure
    tables of the National High Blood Pressure Education Program are
    a prerequisite for classification of childhood hypertension. Although
    these tables provide a reasonable basis, they are intricate and height
    percentile is needed for final diagnosis. Many attempts have been
    done to decrease such complexity. We present new formulas that
    are concise and memorable, and will help physicians to screen
    prehypertensive and hypertensive pediatric patients.
    IJKD 2010;4:

    نویسندگان: Hamidreza Badeli,1 Seyed Aidin Sajedi,2 Maryam Shakiba3
    کلید واژه ها: hypertension, blood pressure determination, child, adolescent
  • خلاصه مقاله:

    Conventional Jaffe method of serum creatinine measurement is
    influenced by several drugs and components of blood as well as
    the expertise of laboratory staffs. We obtained blood samples of
    22 healthy volunteers and sent them to 23 laboratories in Rasht,
    Iran, in which the conventional Jaffe method would be used for
    serum creatinine measurement. Also, we tested the samples in 1
    reference laboratory with the calibrated Jaffe method. Glomerular
    filtration rates were calculated using the abbreviated equation
    of the Modification of Diet in Renal Disease study. Eight of 23
    laboratories (34.7%) reported significantly different mean serum
    creatinine levels from the mean values yielded in the reference
    laboratory. Seven of 23 laboratories (30.4%) had significantly
    different estimated glomerular filtration rates in comparison to
    those calculated in the reference laboratory. Different results for
    creatinine lead to wrong interpretation of patients’ kidney function,
    and rectifications of this divergence are of utmost importance.

    نویسندگان: Hamidreza Badeli,1 Mehrdad Sadeghi,2 Elias Khalili Pour,3 Abtin Heidarzadeh4
    کلید واژه ها: creatinine, glomerular filtration rate, diagnostic tests, laboratory techniques and procedures
  • خلاصه مقاله:

    Objective: Screening of kidney diseases by urinalysis in preschool children was approved in
    many parts of the world with inexpensive tools such as urinary dipsticks. In this study the
    researchers investigate the prevalence of hematuria and proteniuria in 4 to 6‐year‐old children
    in daycare centers of Rasht (Iran).
    Methods: The researchers examined proteinuria and hematuria in 1520 healthy children in
    daycare centers of Rasht. Urine strips were employed to examine the urine which was already
    collected from the subjects. Another urine sample was collected from those children with
    abnormal findings in the first samples with dipstick of the same brand a month later. If any
    positive result was found again, the urine was analyzed with dipstick and microscope
    concurrently.
    Findings: In the first dipstick samples, the prevalence was 3.2% for hematuria, 5.8% for
    proteinuria, and 0.13% for a mixture of proteinuria and hematuria. In the second urinalysis in
    patients with positive findings, hematuria, proteinuria as well as mixed proteinuria and
    hematuria were 20.4%, 52.0%, and 2.0% correspondingly. In the third analysis of samples, the
    abnormal findings in all patients were 13 (0.85%) isolated hematuria, 24 (1.57%) isolated
    proteinuria and one (0.06 %) mixed hematuria and proteiuria.
    Conclusion: This study showed that the prevalence of proteinuria and hematuria during pre-school
    period (4 to 6 year-olds) may reveal relatively similar frequencies of some other studies.

    نویسندگان: Hamidreza Badeli* 1, MD; Abtin Heidarzadeh2, MD; Mohammadreza Ahmadian3, MD
    کلید واژه ها: Proteinuria; Hematuria; Screening; Dipsticks; Urinalysis
  • خلاصه مقاله:

    Objective: The relationship between iron deficiency anemia and febrile convulsions has been examined
    in several studies with conflicting results. The authors aimed to evaluate the relation, if any, of iron status
    with first febrile convulsion.
    Methods: In this case–control study, the authors assessed 200 children with a diagnosis of first febrile
    convulsion, aged between 6 months and 5 years, during March 2005 to September 2006. The control
    group consisted of febrile children without convulsion; controls were matched to the cases by gender
    and age.
    Results: The patients and controls were 22.86  12.86 and 21.91  13.58 months of mean age, respectively.
    The amount of RBC, serum iron, and plasma ferritin were significantly higher, and TIBC was significantly
    lower among the cases with first febrile convulsions than in the controls. The amount of Hb, Hct, MCV, MCH,
    and MCHC were also higher among cases than controls, but differences were not statistically significant. Iron
    deficiency anemia was less frequent among the cases with febrile convulsion, as compared to the controls,
    and its difference was not statistically significant; but there is not a protective effect of iron deficiency against
    development of febrile convulsion (odd ratio = 1.175). The mean of temperature peak on admission was
    significantly higher in the febrile convulsion group (38.74  0.76 8C) compared with the controls
    (38.2  0.67 8C) (P < 0.0001).
    Conclusions: The results of this study suggest that iron deficiency anemia was less frequent among the
    cases with febrile convulsion, as compared to the controls, and there is not a protective effect of iron
    deficiency against febrile convulsions.

    نویسندگان: Elham Bidabadi a,*, Mehryar Mashouf
    کلید واژه ها: Febrile seizure Case–control study Iron deficiency anemia Epilepsy
  • خلاصه مقاله:

    بيماري ت يساكس يك بیماری نادر ژنتيكی- متابوليكي است که با توارث مغلوب اتوزومی به ارث م یرسد. علت آن نقص در آنزيم هگزوزآمينيداز
    در ليزوزومهاي سلولي است. مشخصه بیماری عبارتست از ضعف پيشرونده، از دست رفتن )GM و تجمع گليكواسفنگوليپید )گانگليوزيد 2 ،A
    مهار تهاي حركتي، افزايش واكنش حركتي، كاهش هوشياري از حدود سه تا شش ماهگي از جمله تشنج و كوري و شواهدي از تحليل عصبي
    دو طرفه مشاهده م یشود. در اين گزارش دو مورد کودک مبتلاي cherry red spot در تمام بیماران در معاينه ته چشم نشانه » پيشرونده تقریبا
    به بيماري تي ساكس كه داراي علائم فوق بود هاند گزارش م يشود. بررسی آنزیمی در مورد آنها انجام شد، که در هر دو بیمار کاهش قابل توجه
    مشاهده گرديد.

    نویسندگان: يوسف شفقتي* 1و 2، زهرا هاد يپور 1، فاطمه هاد يپور 1، پیمانه سرخیل 1، مهرداد نوروز ینیا 1و 2 الهام بید آبادی 3، نسرین بزا زبنابی
    کلید واژه ها: بيماري ت یساکس؛ كمبود آنزيم هگزوز آمينيدازايران. ،GM گانگليوزيدوز 2 ،A
  • خلاصه مقاله:
    چکیدهمقدمه: بررسی ویژگیهای مورفولوژی طبیعی جمجمه با اندازهگیری دقیق امکانپذیر است که در مجموع به آن سفالومتری گفته میشود مهمترین بخش سفالومتری اندازهگیری طول و عرض جمجمه است. گیلانیها معروف به صاف بودن پشت سرشان هستند. برای بررسی دقیق ویژگیهای مورفولوژی جمجمه باید از سفالومتری و محاسبه اندکس سفالیک استفاده کرد. هدف: بررسی اختلاف احتمالی اندکس سفالیک گیلانیها با نتایج سایر مطالعات.مواد و روشها: در یک مطالعه آیندهنگر توصیفی طی یک سال بر روی190 فرد گیلانی، از تمام گیلانیهایی که به علل مختلف در بیمارستان پورسینای رشت بستری شده یا بهطور سرپایی مداوا شده و دارای رادیوگرافی ساده رخ و نیم رخ جمجمه بودند استفاده شد. اندکس سفالیک در رادیوگرافی ساده جمجمه افراد با استفاده از خطکش و اندازهگیری نسبت بیشترین عرض به بیشترین طول جمجمه ضرب در صد محاسبه و بررسی آماری شد.نتایج: از 190 فرد گیلانی مورد مطالعه151 نفر مرد و 39 نفر زن با میانگین سنی 8/31 ساله بودند. میانگین بیشترین عرض و بیشترین طول جمجمه به ترتیب 0/1± 358/15 و 1/1±752/17 سانتیمتر بود. میانگین اندکس سفالیک 4/4±4/86 بوده که در محدودهی براکی سفال قرار دارد. در کل 90 درصد افراد جمجمهی براکیسفال و 10 درصد جمجمهی مزوسفال داشتند و هیچ جمجمهی دولیکوسفال مشاهده نشد.نتیجهگیری: در این مطالعه نیز مانند بررسیهای سایر مناطق ایران بر روی بزرگسالان، شکل جمجمه در افراد گیلانی عمدتاً براکیسفال بوده است؛ گرچه این نتایج با یافتههای سایر مناطق دنیا که در آنها اکثر جمجمهها مزوسفال است تفاوت دارد، اما با سایر ساکنان ایرانی تفاوتی ندارد.
    نویسندگان: بیدابادی ا، مشعوف م، خرم نیا س
    کلید واژه ها: سفالومتری/ پرتونگاری جمجمه / جمجمه
  • خلاصه مقاله:

    Objective
    There are few studies evaluating the relative frequency of different etiologies
    of hydrocephalus in pediatric population, in Iran; therefore, this topic was
    considered in the present study.
    Material & Methods
    In a prospective study, the study group consisted of all children fulfilling the
    imaging criteria for having hydrocephalus, aged below 12 years, admitted
    at Rasht 17th Shahrivar and Poursina Hospitals, between March 2006 and
    September 2008. Demographic data and information on the etiology and type
    of hydrocephalus, and surgical and pathological diagnosis were recorded for all
    cases. All data were analyzed with SPSS version 13 software.
    Results
    There were a total of 67 patients, with a mean age of 33.25 ± 43.40 months.
    Hydrocephalus was seen most frequently in the first 2 years of life. Thirty
    three patients (49.3%) were female and 34 (50.7%) were male. Mean age of
    the girls and boys was 30.78 ± 46.46 and 35.64 ± 40.77 months, respectively
    (p=0.650). Communicating and obstructive hydrocephalus was seen in 30
    (44.8%) and 37 cases (55.2%), respectively. There was no statistically significant
    difference in the types of hydrocephalus between the two sex groups. Mean age
    in obstructive and communicating groups was 3.76 ± 46.17 and 35.09 ± 40.42
    months, respectively (p=0.0006). The most common causes of hydrocephalus
    were myelomeningocele for obstructive (19.4% of total cases), and TORCH
    and meningitis for communicating (8.9% of total cases for each).
    Conclusion
    In our study, there was a mild preponderance for male sex and obstructive
    type. Mean age of the patients with obstructive hydrocephalus was significantly
    lower than those with communicating type. Overall, the most common cause
    of hydrocephalus was myelomeningocele.

    نویسندگان: Elham BIDABADI
    کلید واژه ها: Child, Hydrocephalus, Etiology
  • خلاصه مقاله:

    Celiac disease is an autoimmune disease associated with increased risk of several diseases
    including a variety of malignancies. This is the first report of the concomitance of atopic dermatitis
    and Hodgkin’s lymphoma in a child with celiac disease.
    Here, we report an 11-year-old boy with chronic diarrhea, glossitis, chronic dermatitis, and
    megaloblastic anemia who later developed Hodgkin's lymphoma

    نویسندگان: Maryam Jafroodi MD•*, Omid Zargari MD**, Saba Hoda MD
    کلید واژه ها: Anemia • atopic dermatitis • celiac disease • Hodgkin’s lymphoma • pediatrics
  • خلاصه مقاله:

    α thalassemia (α-thal) is one of the most common hemoglobin (Hb) disorders in the world.1 α-globin genes are located on chromosome 16. The majority of α-thal mutations are deletions but point mutations are found as well.2 Since the Iranian population is a mixture of different ethnic groups, frequency and distribution of α-globin mutations in various regions of the country need to be clarified. These findings can contribute to a wider understanding of this disorder.

    نویسندگان: Valeh Hadavi*, Amir Hossein Taromchi*⇓, Mahdi Malekpour*, Behjat Gholami*, Hai-Yang Law°, Navid Almadani*, Fariba Afroozan*, Farhad Sahebjam*, Parisa Pajouh*, Roxana Kariminejad*, Mohammad Hassan Kariminejad*, Azita Azarkeivan*#, Maryam Jafroodi*, Ahmad Tamaddoni@, Helene Puehringer^, Christian Oberkanins^ and Hossein Najmabadi*
    کلید واژه ها: α-thalassemiaو mutations و Iran
  • خلاصه مقاله:

    Purpose: Among the three forms of anthrax in human (cutaneous, inhalational, and gastrointestinal), cutaneous anthrax is the most common form with prevalence of 95%. The cutaneous anthrax is a rare cause of periorbital (preseptal) cellulitis that may remained without correct diagnosis and appropriate treatment. This may result in severe local complications such as blindness and airway obstruction or dissemination of the disease like as bacteremia and meningitis.
    Objective: We report a child with periorbital anthrax to present the clinical manifestation and progression of the disease and remind physicians the interesting contagious cause of periorbital cellulitis.
    Case report: A 2.5-year-old boy from a rural area of Guilan province in Iran was seen to have a small erythematous papule in his right lower eyelid 5 days prior to admission. Then, the lesion progressed to a necrotic ulcer with a black central scar and severe surrounding edema and erythema. Severe swelling of the eyelids and edema all over the face occurred as well. Fever was absent. The child had repetitious contacts with domestic herbivores. The CT scan of the orbit and paranasal sinuses showed soft tissue swelling only. Gram-positive rods were seen in the smear of exudate taken from cutaneous lesion but culture result showed negative. Treatment with intravenous ciprofloxacin, penicillin, and clindamycin resulted in clinical improvement but due to cicatricial ectropion formation, oculoplastic intervention was considered to be done.
    Conclusion: Physicians must consider a cutaneous lesion to be anthrax if any of the following exists: a history of contact with domestic herbivores and animals, similar lesions in the family members, cutaneous necrotic ulcer with the characteristic black scar and peripheral edema, and observing gram-positive rods in scraped material taken from beneath the scar edge or exudate of cutaneous lesions. Although anthrax of the eyelids is not common, it must be included in the differential diagnosis of periorbital cellulitis.

    نویسندگان: Houman Hashemian, MD1 • Hassan Behboudi, MD2 Mohammad-Mehdi Karambin, MD1
    کلید واژه ها: Anthrax, Ectropion, Eyelid, Periorbital Cellulitis
  • خلاصه مقاله:

    Abstract- To determine the rate of different types of arthritis in children. We prepared a retrospective
    descriptive study and included the whole 100 cases of arthritis referred to 17-Shahrivar Hospital, Rasht,
    Guilan during a 3 years period. Using their medical files, data including age, sex, season of admission, history
    of trauma, signs and symptoms, lab findings and duration of hospitalization were collected. SPSS 13.0
    (statistical software) applied for statistical analysis. The most common age of involvement ranged 6-9 years.
    Septic arthritis, brucellosis, and rheumatoid fever were the most frequent causes of arthritis in our study.
    Fever and restricted range of motion had the highest rate among different signs and symptoms. Lab data
    demonstrated leukocytosis, positive CRP, and increased ESR among 74, 79.5, and 73 percent of our patients,
    respectively. According to the high prevalence of septic arthritis and the arthritis due to brucellosis and
    rheumatoid fever, it seems that mentioned diseases are still major problems in the issue of hygiene
    management.

    نویسندگان: Mohammad Mehdi Karambin* and Hooman Hashemian
    کلید واژه ها: Childhood, arthritis, septic, brucellosis
  • خلاصه مقاله:

    Objective: It is propounded that febrile neonates with low risk criteria (LRC) can be carefully
    observed without parenteral antimicrobial therapy; but yet, reliability of LRC to exclude serious
    bacterial infection (SBI) is uncertain.
    Methods: The records of all febrile term neonates, seen in the emergency room and admitted in
    neonatal ward of 17 Shahrivar children's hospital of Rasht, Iran from January 2004 to January 2009
    were reviewed. All of them underwent full sepsis workup. The prevalence of SBI in total population
    and LRC positive and negative neonates were calculated
    Findings: A total of 202 records of previously healthy febrile neonates were evaluated. SBI was
    shown in 38 (18.8%). The most common type of SBI was urinary tract infection (UTI). Sixty-two
    (31%) neonates had LRC, and only one (1.6%) had SBI (UTI with E. coli). SBI was significantly more
    common in neonates without LRC (26.6% versus 1.6%, P<0.001). The negative predictive value
    (NPV) of LRC to exclude SBI was 98.4% (95%confidence interval: 96.7% to 100%).
    Conclusion: These findings suggest that LRC may be relied upon to exclude SBI in febrile neonates.
    We propose that all febrile neonates be admitted, ill or LRC negative neonates should undergo a full
    sepsis work up and be administered systemic antibiotics immediately. LRC positive neonates should
    be under close observation.

    نویسندگان: Marjaneh Zarkesh*, MD; Houman Hashemian, MD; Mohammad Momtazbakhsh, MD,and Tahereh Rostami, MD
    کلید واژه ها: Low-risk criteria; Neonate; Serious bacterial infection
  • خلاصه مقاله:

    زمينه و هدف: عفونت دستگاه ادراري از علل اصلي اسكار كليه محسوب م يشود كه خود عوارضي جدي همچون
    هيپرتانسيون يا نارسايي مزمن كليه را در پي دارد. اين مطالعه براي تبيين تاثير درگيري پارانشيم كلي ه طي عفونت
    در بروز اسكاركليوي (VCUG/RNC فاز حاد) و ريفلاكس وزيكواورترال (بر مبناي DMSA ادراري اوليه (بر مبناي اسكن
    تأخيري) انجام شده است. روش بررسي: تعداد 103 كودك بستري در بيمارستان مركز طبي DMSA (بر مبناي اسكن
    اوليه و DMSA كودكان مبتلا به اولين نوبت عفونت دستگاه ادراري مورد مطالعه قرار گرفتند. سن، وزن، نتايج اسكن
    DMSA تأخيري به عمل آمد. سپس نتايج اسكن DMSA 4 ماه بعد، از هر بيمار يك اسكن - آنها ثبت شد. 6 VCUG/RNC
    مقايسه گرديد. يافت هها: در جمعيت مورد مطالعه ما ( 103 كودك مبتلا به VCUG/RNC حاد و تأخيري به تفكيك نتايج
    84 %) دختر بودند. در موارد / 15 %) پسر و 87 نفر ( 5 / 27 ماه بوده و 16 نفر ( 5 /2±27/ عفونت ادراري)، ميانگين سني 7
    دچار ريفلاكس وزيكواورترال و فقدان آن، فراواني ضايعات پايدار يا همان اسكار در كليه هاي دچار پيلونفريت
    84 % و / 18 %) فرق معن يداري نداشت ولي در پيلونفريت شديد ( 6 / 33 % و 2 / 8%) و متوسط ( 3 / 28 % و 7 / خفيف ( 6
    همچنين فراواني بروز اسكار در كلي ههاي دچار .(p=0/ %23/1 ) در صورت وجود ريفلاكس واضحاً بالاتر بود ( 005
    ،%33/3 ،%28/6 ،%8/ ريفلاكس با تشديد پيلونفريت (طبيعي، خفيف، متوسط، و شديد) افزايش معن يداري نشان داد ( 3
    نتيج هگيري: .(p=0/062 ،%23/ 1 ،%18/2 ،%10/ ولي در گروه فاقد ريفلاكس چنين نبود (صفر، 3 (p=0/001 ،%84/6
    در اين مطالعه مشخص شد كه نه تنها بروز اسكار در موارد پيلونفريت شديد داراي ريفلاكس بالاست بلكه م يتوان بر
    حدود خطر احتمال ابتلا به اسكار كليوي را تخمين زد. ،VCUG/RNC اوليه و DMSA اساس نتايج اسكن

    نویسندگان: هومان هاشميان 1 پرويز طباطبايي 2 سيد احمد سيادتي 2 نعمت الله عطايي
    کلید واژه ها: ريفلاكس وزيكواورترال، عفونت دستگاه ادراري، كودكان.
  • خلاصه مقاله:

    Abstract- To review children with Kawasaki disease admitted in 17-Shahrivar hospital of Rasht from 1999
    to 2007. We reviewed retrospectively 64 children with Kawasaki disease between 1999-2007 admitted in 17-
    Shahrivar Hospital of Rasht. Frequency distributions of variants including age, sex, season, clinical and laboratory
    manifestations, response to treatment and complications of the patients were abstracted using SPSS
    14. Patients' age ranged from 2 month to 12 years (median: 41.5 months). The male / female ratio was 1:0.78.
    The most cases were admitted in the autumn and then spring. Fever in 100%, changes in lip and mouth in
    92.1%, rash in 87.5%, Conjunctivitis in 82.8%, changes in extremities in 67.1%, and cervical lymphadenopathy
    in 59.3% were present. Coronary aneurysm was found in one case. The most common extracardiac complication
    in this study was vomiting (85.7%). With respect to Kawasaki disease differential diagnosis and its
    treatment, Better knowledge can help us to make diagnosis more accurately.

    نویسندگان: Houman Hashemian* and Mohammad Mahdi Karambin
    کلید واژه ها: Epidemiology; mucocutaneous lymph node syndrome
  • خلاصه مقاله:

    Abstract- There is a lack of large, prospective epidemiologic studies concerning acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in pediatric population. To determine the different causes of respiratory distress in children, we performed a retrospective study and included 567 children with respiratory distress referred to our hospital. Using their medical files, data including age, sex, and causes of respiratory distress were collected. SPSS 13.0 (statistical software) applied for statistical analysis. Pneumonia, asthma, and croup were the major causes of ARDS in children with a rate of 38.4, 19.04, and 16.5 percent, respectively. It seems that infectious factors are at the top of the list of ARDS causing factors which must be considered in approach and management of such patients. We suggest vaccinating these at risk groups against common infectious agents such as Hemophilus influenza and respiratory syncytial virus (RSV) which can either cause pneumonia or induce asthma.

    نویسندگان: M. M. Karambin* and H. Hashemian
    کلید واژه ها: Acute lung injury, acute respiratory distress syndrome, pneumonia, asthma
  • خلاصه مقاله:

    Objective: Bacterial sepsis continues to be a major cause of morbidity and mortality in newborns.
    Bacterial pathogens of neonatal septicemia may vary from one country to another and within a
    country from one hospital or region to another. Both gram-negative and gram-positive bacteria are
    responsible in neonatal sepsis. This study was undertaken to determine the prevalent bacterial
    agents of neonatal sepsis and their antimicrobial susceptibility in a teaching hospital, Rasht, from
    February 2008 to February 2010.
    Methods: This prospective study includes 611 newborns admitted with the probable diagnosis of
    septicemia. We studied the cases with positive blood culture, the pathogens and antibiotic
    resistance to different antibiotics.
    Findings: Among 611 hospitalized newborns, 64 (10.6%) cases had positive blood culture. The
    commonest pathogens were Entrobacter (78.1%) and Klebsiella (6.2%).
    Conclusion: According to the results, low birth weight and prematurity were associated with
    higher risk of sepsis significantly. The most common pathogen was Enterobacter. Treatment with
    effective antibiotics (e.g. gentamicin, cost effective and easily available) and hygienic care in the
    neonatal unit are recommended to eliminate the infectious factors especially Entrobacter.

    نویسندگان: Mohammad-Mehdi Karambin*, MD, and Marjaneh Zarkesh, MD
    کلید واژه ها: Neonate; Sepsis; Antibiotics; Drug Resistance; Entrobacter; Bacterial Infection
  • Summary:

    Urinary reflux can cause irreversible complications such as reflux nephropathy and ESRD. Diagnostic imaging such as voiding cystourethrogram (VCUG) is invasive and causes irradiation. Several studies have shown that markers such as urine IL-8 or serum Procalcitonin might be useful for the diagnosis of vesico-ureteral reflux (VUR) as a substitution for invasive methods. The aim of this study was to determine and compare the mean urine Ca/Cr ratio and hypercalciuria between two groups of children aged 2-10 years affected by VUR. This is a cross-sectional study in which 32 chil­dren having the following entrance criteria were included: children 2-10 years old not affected by uri­nary tract infection during the last three months and their reflux or recovery having been diagnosed by VCUG or direct radionuclide cystography, divided into two groups of affected by reflux and recovered from reflux. Then, the point urine specimens were collected with permission of their parents in a single laboratory and urine Ca and Cr for each specimen were measured. The Ca/Cr ratio was calculated for each child to evaluate Ca excretion from the urine, which was possible without collecting the 24-hours urine. The Ca/Cr ratio mean and the hypercalciuria were compared between the groups. To analyze our data, the Mann-Whiney test and the Chi-square test were used, using SPSS V.15. Thirty-two children, including 18 children recovered from reflux and 14 affected by reflux, were entered in our study. The Ca/Cr ratio mean was 0.692 ± 1.874 for the affected and 0.118 ± 0.187 for the recovered group. The Ca/Cr ratio mean for the affected male and female groups was 0.012 ± 0.008 and 0.805 ± 1.0913, respectively. This amount was 0.0175 ± 0.01767 for the recovered male and 0.131 ± 0.195 for the recovered female group. There was no significant statistical difference between the groups with res­pect to the Ca/Cr ratio mean, but there was a significant statistical difference between the two groups of females (P-value = 0.026). Also, there was no significant statistical difference between the two groups of males relative frequency of hypercalciuria was significantly higher in the group affected by reflux than in the recovered from reflux group (P-value = 0.017). Urine Ca excretion is elevated in children with reflux, and may be more useful as an appropriate marker for the diagnosis of VUR than other invasive methods.

    Authors: Badeli H, Sadeghi M, Shafe O, Khoshnevis T, Heidarzadeh A.
    Keywords: urine , calcium, children, vesicoureteral reflux
  • Summary:

    Abstract

    BACKGROUND:

    Migraine is the most common of the paroxysmal disorders to affect the brain in the pediatric population. Both propranolol and sodium valproate (valproic acid) have been advocated as prophylactic agents for childhood migraine.

    OBJECTIVE:

    To compare the efficacy and tolerability of propranolol and sodium valproate in the prevention of migraine in the pediatric population.

    METHODS:

    Sixty-three children (aged 5-15 years) with migraine without aura, as defined by the 2004 International Headache Society (IHS) criteria, were included in this prospective, double-blind clinical trial and were randomly assigned to two groups. Group A (n = 32 patients) received propranolol 3 mg/kg/day and group B (n = 31 patients) received sodium valproate 30 mg/kg/day, with at least 6 months of follow up. The propranolol dosage was adjusted to 2 mg/kg/day and the sodium valproate dosage to 15 mg/kg/day, after the first follow-up visit. Participants were evaluated by using a detailed questionnaire that asked about the features of headaches and general health characteristics. The study endpoints were successful treatment for a 4- to 6-month period; 3 months of a persistent unsuccessful or incomplete response to treatment; intolerable side effects; and/or patient non-adherence. All data were analyzed longitudinally by comparing baseline data with data from each follow-up.

    RESULTS:

    A total of 60 patients completed the full headache prophylaxis period. The baseline headache frequency was reduced by more than 50% in 83% of propranolol recipients and in 63% of sodium valproate recipients (statistically not significant); the overall reduction of baseline headache frequency per month was better in group A (p = 0.044). The mean headache frequency per month was reduced from 13.86 +/- 2.11 to 4.23 +/- 3.24 in group A, and from 13.23 +/- 2.43 to 5.83 +/- 4.04 in group B; the difference between the two groups was statistically significant (p < 0.01). The mean headache duration per week was decreased from 9.9 +/- 7.4 hours to 3.2 +/- 5.9 hours in group A, and from 9.1 +/- 6.9 hours to 3.7 +/- 5.0 hours in group B; although there was no statistically significant difference between propranolol and sodium valproate, headache duration was markedly improved with each drug (p < 0.002). Reduction of headache severity by at least one grade was seen in 64% of patients in group A and in 56% in group B, and complete cessation of headache attacks occurred in 14% of patients in group A and 10% in group B (not significant). Minor side effects appeared to be fairly well tolerated by patients in both groups, with no significant difference in side effects between the two groups.

    CONCLUSION:

    This prospective study supports the efficacy of propranolol and sodium valproate as prophylaxis for pediatric migraine without aura, based on IHS criteria. There were no significant differences between these two drugs in all evaluated parameters except for the mean headache frequency per month, which was lower with propranolol than with sodium valproate.

    Authors: Bidabadi E, Mashouf M.
    Keywords: propranolol, sodium valproate, migraine , pediatric
  • Summary:

    Purpose Hyperglycemia is a common secondary insult associated
    with an increased risk of mortality and poor outcome
    in traumatic brain injury (TBI), but the effect of
    hyperglycemia on outcomes of severe TBI in children and
    adolescents is less apparent. The aim of this study was to
    evaluate the association of hyperglycemia with mortality in
    pediatric patients with severe TBI.
    Methods In this cross-sectional study, data of all children
    and adolescents with severe TBI admitted to Poursina Hospital
    in Rasht, including age, gender, Glasgow Coma Scale
    (GCS) upon admission, mortality rate, hospital length of
    stay, and serial blood glucose during the first three consecutive
    ICU days following admission, were reviewed from
    April 2007 to May 2011. After univariate analysis and
    adjustment for related covariates, logistic regression model
    was established to determine the association between persistent
    hyperglycemia and outcome.
    Results One-hundred and twenty-two children were included
    with a median admission GCS of 6 (interquartile range
    (IQR) 5–7) and a median age of 13 years (IQR 7.75–17).
    Among them, 91 were boys (74.6 %) and 31 were girls
    (26.6 %); the overall mortality was 40.2 % (n049). Patients
    who died had a significantly greater blood glucose levels
    than survivors for the first 3 days of admission (P00.003,
    P<0.001, P00.001, respectively). Moreover, persistent hyperglycemia
    during the first 3 days of admission had an
    adjusted odds ratio of 11.11 for mortality (P<0.001).
    Conclusion Early hyperglycemia is associated with poor
    outcome, and persistent hyperglycemia is a powerful and
    independent predictor of mortality in children and adolescents
    with severe TBI.

    Authors: Seyed Mohammad Seyed Saadat & Elham Bidabadi & Seyedeh Nazanin Seyed Saadat & Mehryar Mashouf & Fatemeh Salamat & Shahrokh Yousefzadeh
    Keywords: Brain injury . Hyperglycemia . Mortality . Child
  • Summary:

    Purpose of the study: to determine the efficacy, adverse effects and safety of a new Iranian generic product of deferasirox (Osveral®) in Iranian transfusion dependent major thalassemic (TD-MT) patients.
    Methods: In 9 main thalassemia treatment centers, all of TD-MT patients (aged ≥2 yrs) with serum ferritin (SF) levels≥1000 ng/ml, or >100 ml/kg of RBC transfusion ,who could not tolerate parental iron chelating were recruited regardless of their previous iron chelation therapy. Periodical clinical and laboratory evaluations were conducted for adverse effects (AEs). Primary efficacy end point was Mean of Relative Change of Serum Ferritin (MRC-SF) from the baseline level during one year. Analysis of variance (ANOVA), t test, chi-square or Fisher exact test were used for statistic analysis appropriately (P values <0.05 were considered as statistical significant).
    Results: In 407 cases the male/female ratio was 0.98. Mean age was 11.5±7.4 (2-58) years. The mean of initiating dose of Osveral® and mean usage dose during the study was 23.5±4.9 mg/kg and 24.9 ± 4.9 mg/kg respectively. MRC-SF was -11.44% ±38.92 and it showed significant decline in SF (P value<0.001) one hundred and forty eight patients out of 407 patients experienced at least one. AE, the most common of them were transient increase in serum creatinin (97;24.1%) and > 5 time increase in transaminases (24;5.89%).The causes of discontinuation of treatment were non-satisfactory treatment ( 24; 5.8%), poor or non-compliance of patients (21;5.1%), and adverse effects (13; 3.1%) .
    Conclusion: A detailed comparison with similar studies on deferasirox (Exjade®) shows a promising efficacy and safety for its Iranian generic product (Osveral ®).

    Authors: 1Eshghi P., 2Farahmandinia Z. , 3Molavi M., 4Naderi M. , 5Jafroodi M. , 6Hoorfar H., 7Davari K., 8 Azarkeivan A., 9Keikhaie B. , 10 Ansari S., 11Arasteh M
    Keywords: Thalassemia, Iron Chelation , Osveral ®, Deferasirox ,Safety, Efficacy
  • Summary:

    BACKGROUND:

    Beta thalassemia major patients are vulnerable to transfusion-transmitted infection, especially hepatitis C virus (HCV), and iron overload. These comorbidities lead to cirrhosis and hepatocellular carcinoma in these patients. In order to prevent these complications, treatment of HCV infection and regular iron chelating seems to be necessary. The aim of this study was to evaluate the effect of hepatic iron concentration (HIC) and viral factors on the sustained virological response (SVR) in chronic HCV-infected patients, with beta thalassemia major being treated with interferon and ribavirin.

    MATERIALS AND METHODS:

    We enrolled 30 patients with thalassemia major and chronic HCV who were referred to the Hematology Clinic of Guilan University of Medical Sciences, between December 2002 and April 2006. HIC was measured by atomic absorption spectroscopy before treatment. The viral factors (viral load, genotype) and HIC were compared between those who achieved a SVR and nonresponders.

    RESULTS:

    Mean age of the 30 thalassemic patients, was 22.56 ± 4.28 years (14-30 years). Most patients were male (56.7%). Genotype 1a was seen in 24 (80%) cases. SVR was achieved in 15 patients (50%). There were no significant correlations between HIC (P = 1.00), viral load (P = 0.414), HCV genotype (P = 0.068), and SVR. No difference was observed in viral load (P = 0.669) and HIC (P = 0.654) between responders and nonresponders.

    CONCLUSION:

    HIC, HCV viral load, and HCV genotype were not correlated with virological response, and it seems that there is no need to postpone antiviral treatment for more vigorous iron chelating therapy.

    Authors: Jafroodi M, Asadi R, Heydarzadeh A, Besharati S
    Keywords: hepatic iron concentrationو interferon و hepatitis Cو thalassemia major
  • Summary:

    Background: In Iran, diarrheal disease is the fourth cause of
    under five‑year mortality. Proper care‑seeking behavior and
    system‑based disease management in the national field will have a
    great effect in reducing morbidity and mortality.
    Methods: This nationwide study was performed on a target
    population of rural and urban communities; in all 31 provinces of
    the Islamic Republic of Iran. One lakh three thousand three hundred
    and thirty one (103331) families were sampled by multi‑stage
    stratified random sampling and were interviewed with a standard data
    collection form. The collected data was entered into the Stata 8.0
    software and analyzed by the survey analysis method.
    Results: Of the 14625 (10.1%) children who were reported to
    have diarrheal diseases two weeks prior to the interview, 8.8%
    were cured and 1.5% were not. About 70% of them had at least
    one visit for health seeking the most of patients were seen by
    a rural health worker (Behvarz) in the rural and by a general
    pediatrician in the urban areas. About 62% of the patients in
    urban and 57% in the rural areas had been treated with antibiotics
    and these rates for ORS were 51% and 65%, respectively. The
    factors most related to a care‑seeking pattern were the level of
    routine preventive well‑child care, number of siblings, child age,
    and living area.
    Conclusion: According to this national survey, our health system
    needs to integrate all the levels of prevention, especially the
    Integrated Management of Child Illnesses (IMCI) programs with
    a family physician project. Futher more, there is a great need for
    empowering the referral system and gate keeping in all referral
    levels, to make efficient national integrated programs.

    Authors: Mohammad Esmail Motlagh, Abtin Heidarzadeh2, Houman Hashemian1, Mehrnaz Dosstdar
    Keywords: Diarrhea, antibiotic, health service, national survey, preventive child care, referral system, Iran
  • Summary:

    Introduction: Vesicoureteral reflux (VUR) is a risk factor for kidney scarring, hypertension and declining renal function. Standard diagnostic methods are invasive and can cause exposure to radiation and urinary tract infections (UTIs). We aimed to investigate urine albumin and interleukin-8 levels as markers of ongoing VUR and renal damage in children without UTIs.
    Methods: Random urine samples were collected from 51 children, including 16 children with VUR (group A), 17 children with resolved VUR (group B) and 18 normal children (group C). The diagnosis of VUR or resolved VUR was confirmed by voiding cystourethrogram (VCUG) or direct radionuclide cystography (DRNC). All children had normal kidney function and had no evidence of UTI in the preceding three months. Random urine specimens were assayed for albumin (Alb), creatinine (Cr) and interleukin-8 (IL-8) and mean values were compared by one way ANOVA.
    Results: In groups A and B, the mean age at first UTI was 31.7 ± 2.4 and 27 ± 2.0 months respectively. In group A, the mean duration between VUR diagnosis and study entrance was 30 ± 9.1 months. In group B, the mean duration between VUR diagnosis and recovery was 19.9 ± 1.3 months. Overall, 76.4% of affected children had bilateral VUR and 41.2% had severe VUR. There were no significant differences in urinary Alb, IL-8, Alb/Cr and IL-8/Cr between the three groups.
    Conclusion: The current study does not support the hypothesis that microalbuminuria or urinary IL-8 are good indicators of ongoing VUR and renal injury in children.
     

    Authors: H Badeli, T Khoshnevis, AH Rad, M Sadeghi
    Keywords: Children; Interleukin-8; Microalbuminuria; Vesicoureteral Reflux
  • Summary:

    In recent years, based on controversial issues regarding the diagnosis, treatment and follow up in patients with febrile urinary tract infection (UTI), various investigations have been performed and conventional methods have been modified. Hence, American Academy of Pediatrics (AAP 1999 and 2011) and National Institute for Health and Clinical Excellence (NICE 2007) designed guidelines to justify a method for diagnosis, treatment and follow- up of UTI. The current revised version (AAP 2011) has important changes in approaching febrile UTI in 2- to 24-month infants such as the necessity of performing urinalysis and urine culture, revised sampling methods, modified treatment methods (parenteral or oral therapy), radiological follow-up, and finally antibiotic administration. The aim of this study was to summarize the recent AAP guideline (2011) and present a simpler algorithm.

    Authors: Hamidreza Badeli,¹ Afagh Hassanzadeh Rad,¹´²
    Keywords: Urinary Tract Infections; Infants; Child; Vesico-Ureteral Reflux
  • Summary:

    Introduction: Acute gastroenteritis (AGE) is one of the most common infectious

    illnesses of childhood. While no treatment is needed for self-limited virus-

    induced AGE, dehydration caused by diarrhea and emesis is of great concern and

    should be treated vigorously. However, there is no consensus on the most

    appropriate electrolyte composition of intravenous fluids; therefore, according

    to basic protocols in our hospital which suggest hypotonic fluid therapy for AGE,

    investigators aimed to assess the frequency of hyponatremia in gastroenteritis

    patients treated with intravenous hypotonic fluid therapy.

    Materials and methods: This descriptive observational study was conducted at

    17 Shahrivar Pediatrics Hospital between September 2008 and January 2011.

    The patients’ medical records were assessed and children aged between 1 month

    and 14 years with a diagnosis of gastroenteritis and dehydration were enrolled

    in the study. According to sodium concentration at T0, patients were divided into

    three groups: hyponatremic, hypernatrmic and isonatremic. The blood samples

    were analyzed for the sodium concentration at T0 and during 24 hours.

    Statistical analyses were performed by T test and chi-square using SPSS18 and

    statistical significance was defined as a p-value less than 0.05.

    Results: The mean age of the participants was 16.4311.1 months; 58 patients

    were male (67.4%) and 28 were female (32.6%). At T0, 35 patients (40.7%)

    were hyponatremic, 2 patients (2.3%) were hypernatremic and 49 patients were

    isonatremic. Sodium concentration in the hyponatremic and isonatrmic group

    were 137.251.9 and 138.292.04 mEq/L respectively which showed a

    significant difference (p=0.028).

    Conclusion: Our study showed that increased sodium intake could decrease

    acquired hyponatremia. It seems that hyponatremia could be prevented by

    administering high sodium concentration fluids.

    Authors: Badeli HR, Golshekan K, Shahrdami M, Azizi Asl MR, Hassanzadeh Rad A.
    Keywords: Hyponatremia; Gastroenteritis; Hypotonic Solution; Intravenous
  • Summary:

    Objective: The aim of this study was to determine the effect of oral ondansetron in decreasing the vomiting due to acute gastroenteritis in children. Methods: In a single center, randomized, double blind, controlled trial, the effect of oral ondansetron was compared with placebo on 176 patients between 1 and 10 years old with acute gastroenteritis. 30 minutes after drug administration, oral rehydration therapy (ORT) was initiated. Severity of vomiting was evaluated during emergency department (ED) stay and 48 hours follow up. Data were collected and analyzed by SPSS16. Findings: Fifty two of children (58.5%) were males with the mean age of 3.12 (±2.30) years. Ten patients in ondansetron and 14 in placebo group had persistent vomiting during ED stay. After analyzing, there was no significant relation between vomiting in 4 and 48 hours and need for intra venous fluid therapy between the two groups although ondansetron generally decreased ORT failure (P=0.03). Conclusion: Although administrayion of oral ondansetron in gastroenteritis could decrease failure of ORT, it seems that further well-conducted clinical studies are needed to determine effects of oral ondansetron precisely.

    Authors: Golshekan, Kioomars; Badeli, Hamidreza; Rezaieian, Saman; Mohammadpour, Haniyeh; Hassanzadehrad, Afagh
    Keywords: Ondansetron; Acute Gastroenteritis; Vomiting; Oral Rehydration Therapy
  • Summary:

    Introduction: Vesicoureteral reflux (VUR) is a risk factor for kidney scarring, hypertension and declining renal function. Standard diagnostic methods are invasive and can cause exposure to radiation and urinary tract infections (UTIs). We aimed to investigate urine albumin and interleukin-8 levels as markers of ongoing VUR and renal damage in children without UTIs.

    Methods: Random urine samples were collected from 51 children, including 16 children with VUR (group A), 17 children with resolved VUR (group B) and 18 normal children (group C). The diagnosis of VUR or resolved VUR was confirmed by voiding cystourethrogram (VCUG) or direct radionuclide cystography (DRNC). All children had normal kidney function and had no evidence of UTI in the preceding three months. Random urine specimens were assayed for albumin (Alb), creatinine (Cr) and interleukin-8 (IL-8) and mean values were compared by one way ANOVA.

    Results: In groups A and B, the mean age at first UTI was 31.7 ± 2.4 and 27 ± 2.0 months respectively. In group A, the mean duration between VUR diagnosis and study entrance was 30 ± 9.1 months. In group B, the mean duration between VUR diagnosis and recovery was 19.9 ± 1.3 months. Overall, 76.4% of affected children had bilateral VUR and 41.2% had severe VUR. There were no significant differences in urinary Alb, IL-8, Alb/Cr and IL-8/Cr between the three groups.

    Conclusion: The current study does not support the hypothesis that microalbuminuria or urinary IL-8 are good indicators of ongoing VUR and renal injury in children.

     

    Authors: Hamidreza Badeli*, Termeh khoshnevis, Afagh Hassanzadeh Rad, Mehrdad Sadeghi
    Keywords: Children; Interleukin-8; Microalbuminuria; Vesicoureteral Reflux.
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